BILL NUMBER: AB 1269 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 14, 2009
INTRODUCED BY Assembly Member Brownley
FEBRUARY 27, 2009
An act to amend Section 14007.9 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1269, as amended, Brownley. Medi-Cal: eligibility.
Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is partially governed and funded by federal Medicaid
provisions.
Existing law, subject to the receipt of federal financial
participation, requires the department to adopt a federal option
under which any employed individual with a disability who meets
specified income and resource requirements, shall be eligible for
benefits under the Medi-Cal program, subject to the payment of
premiums.
This bill would , to the extent that federal financial
participation is available, authorize individuals who are
otherwise eligible under this program but who are temporarily
unemployed to elect to remain on Medi-Cal pursuant to these
provisions for a period up to 26 weeks, as provided. This bill would
also provide additional resource exemptions in determining Medi-Cal
eligibility under these provisions. The bill would extend specified
resource exemptions to apply for the beneficiary under any other
Medi-Cal program under which the beneficiary later becomes eligible
for medical assistance where that eligibility is based on age,
blindness, or disability.
Existing law requires individuals who are eligible for Medi-Cal
benefits pursuant to these provisions to be subject to premiums that
are determined by a sliding scale that is based on countable income,
as provided.
This bill, not later than March 1, 2010, would, instead, require
each individual to pay a monthly premium that is equal to 5% of his
or her individual or spousal countable income, as described, except
that the premium cannot fall below or exceed a specified minimum and
maximum premium payment, as provided.
The bill would require the above-described provisions to be
implemented only to the extent that federal financial participation
is available, and only to the extent that the department seeks and
obtains approval of all necessary state plan amendments.
Because counties are required to make Medi-Cal eligibility
determinations and this bill would extend the expansion of Medi-Cal
eligibility, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14007.9 of the Welfare and Institutions Code is
amended to read:
14007.9. (a) (1) The department shall adopt the option made
available under Section 1902(a)(10)(A)(ii)(XIII) of the federal
Social Security Act (42 U.S.C. Sec. 1396a(a)(10)(A)(ii)(XIII)). In
order to be eligible for benefits under this section, an individual
shall be required to meet all of the following requirements:
(A) His or her net countable income is less than 250 percent of
the federal poverty level for one person or, if the deeming of
spousal income applies to the individual, his or her net countable
income is less than 250 percent of the federal poverty level for two
persons.
(B) He or she is disabled under Title II of the federal Social
Security Act (Subch. 2 (commencing with Sec. 401), Ch. 7,
Title 42 U.S.C.), Title XVI of the federal Social Security Act
(Subch. 16 (commencing with Sec. 1381), Ch. 7, Title 42, U.S.C.), or
Security Act (42 U.S.C. Sec. 401 et seq.), Title XVI
of the federal Social Security Act (42 U.S.C. Sec. 1381 et seq.), or
Section 1902(v) of the federal Social Security Act (42 U.S.C.
Sec. 1396a(v)). An individual shall be determined to be eligible
under this section without regard to his or her ability to engage in,
or actual engagement in, substantial gainful activity, as defined in
Section 223(d)(4) of the federal Social Security Act (42 U.S.C. Sec.
423(d)(4)).
(C) Except as otherwise provided in this section, his or her net
nonexempt resources, which shall be determined in accordance with the
methodology used under Title XVI of the federal Social Security Act
(42 U.S.C. Sec. 1381 et seq.), are not in excess of the limits
provided for under those provisions.
(2) To the extent federal financial participation is available,
individuals otherwise eligible under this section, but who are
temporarily unemployed, may elect to remain on Medi-Cal under this
section for up to 26 weeks, provided the individuals continue to pay
premiums during the temporary period of unemployment.
(b) (1) Countable income shall be determined under Section 1612 of
the federal Social Security Act (42 U.S.C. Sec. 1382a), except that
the individual's disability income, including all federal and state
disability benefits and private disability insurance, shall be
exempted. Resources excluded under Section 1613 of the federal Social
Security Act (42 U.S.C. Sec. 1382b) shall be disregarded.
(2) Resources in the form of employer or individual retirement
arrangements authorized under the Internal Revenue Code shall be
exempted as authorized by Section 1902(r) of the federal Social
Security Act (42 U.S.C. Sec. 1396a(r)).
(3) To the extent that federal financial participation is
available under Section 1902(r)(2) of the federal Social Security Act
(42 U.S.C. Sec. 1396a(r)(2)), retained earned income of an eligible
(3) Retained earned income of an
eligible individual who is receiving health care benefits under
this section shall be considered an exempt resource when held in a
separately identifiable account and not commingled with other
resources , as authorized by Section 1902(r)(2) of
the federal Social Security Act (42 U.S.C. Sec. 1396a(r)(2)) .
(4) Social security disability income that converts to social
security retirement income upon the retirement of an individual,
including any increases in the amount of that income, shall be
exempt. The department shall submit a state plan amendment for this
specific exemption, and the exemption shall be implemented only if,
and to the extent that, the state plan amendment is approved.
(c) All resources exempted pursuant to paragraph (2) of
subdivision (b) for an individual who is receiving health care
benefits under this section shall continue to be exempt under any
other Medi-Cal program that is subject to Section 1902(r)(2) of the
federal Social Security Act (42 U.S.C. Sec. 1396a(r)(2)) under which
the beneficiary later becomes eligible for medical assistance where
that eligibility is based on age, blindness, or disability. The
department shall submit a state plan amendment for this specific
exemption, and the exemption shall be implemented only if, and to the
extent that, the state plan amendment is approved.
(d) After an individual is determined eligible for Medi-Cal
benefits under this section, the individual's countable income, as
determined under Section 1612 of the federal Social Security Act (42
U.S.C. Sec. 1382a), shall be used to determine the amount of the
individual's required premium payment, as described in subdivision
(f). Disability income and converted retirement income made exempt
under paragraph (1) of subdivision (b) for eligibility purposes shall
be considered countable income for purposes of determining the
amount of the required premium payment.
(e) Medi-Cal benefits provided under this chapter pursuant to this
section shall be available in the same amount, duration, and scope
as those benefits are available for persons who are eligible for
Medi-Cal benefits as categorically needy persons and as specified in
Section 14007.5.
(f) (1) Individuals eligible for Medi-Cal benefits under this
section shall be subject to the payment of premiums determined under
this subdivision. Each individual shall pay a monthly premium that is
equal to 5 percent of his or her individual countable income, as
defined in subdivision (d), or if the deeming of spousal income of an
ineligible spouse applies, a monthly premium that is equal to 5
percent of the total countable income of both spouses, except that
the minimum premium payment per eligible individual shall be twenty
dollars ($20) per month, and the maximum premium payment per eligible
individual shall be two hundred fifty dollars ($250) per month.
(2) The amendments made to this subdivision during the 2009-10
Regular Session shall be implemented no later than March 1, 2010.
(g) In order to implement the collection of premiums under this
section, the department may develop and execute a contract with a
public or private entity to collect premiums, or may amend any
existing or future premium-collection contract that it has executed.
Notwithstanding any other provision of law, any contract developed
and executed or amended pursuant to this subdivision is exempt from
the approval of the Director of General Services and from the Public
Contract Code.
(h) Notwithstanding the rulemaking provisions of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, the department shall implement, without taking
any regulatory action, this section by means of an all-county letter
or similar instruction. Thereafter, the department shall adopt
regulations in accordance with the requirements of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code.
(i) Notwithstanding any other provision of law, this section shall
be implemented only if, and to the extent that, the department
determines that federal financial participation is available pursuant
to Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396
et seq.) and only to the extent that the department seeks and
obtains approval of all necessary Medicaid state plan amendments.
(j) If any provision of this section, or its application, is held
invalid by a final judicial determination, it shall cease to be
implemented. A determination of invalidity shall not affect other
provisions or applications of this section that can be given effect
without the implementation of the invalid provision or application.
SEC. 2. If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.